| NPI | 1164958518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA R HERNANDEZ Clinical Services Coordinator 310-914-4045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2017-05-04 |